Provider Demographics
NPI:1932474251
Name:REYNOLDS, TOREY DENISE (CSC-AD)
Entity Type:Individual
Prefix:
First Name:TOREY
Middle Name:DENISE
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:CSC-AD
Other - Prefix:
Other - First Name:TOREY
Other - Middle Name:DENISE
Other - Last Name:ROYSTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10400 RIDGLAND RD
Mailing Address - Street 2:STE. 1
Mailing Address - City:COCKEYSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21030-2715
Mailing Address - Country:US
Mailing Address - Phone:410-628-6120
Mailing Address - Fax:410-628-9825
Practice Address - Street 1:7801 YORK RD
Practice Address - Street 2:STE. 203
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-7446
Practice Address - Country:US
Practice Address - Phone:410-825-7077
Practice Address - Fax:410-628-9825
Is Sole Proprietor?:No
Enumeration Date:2012-03-20
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDSC0343101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)